Name*

Name of the Group or School (if applicable)

Email address*

Telephone (mobile number preferred)

Type of visit*

Visit SEVT's shop at MIT Have SEVT come to your location (please describe in Comments)

Nature of visit*

Individual School group Corporate Energy event Other (please describe in Comments)

Preferred date

January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2008 2009 2010

Preferred time (leave blank if no preference)

Other possible dates (e.g. June 10-12, 2009 or Any Saturday in March)

Number of guests (including yourself)*

Age of guests

0-10 years old 11-15 years old 16-20 years old 21-30 years old over 30 years old

Comments or Special Requests